Background: 

Surgeons have hesitated to use steroids in patients undergoing posterior spinal fusion because of the risk of wound complications. The literature has supported the use of postoperative steroids in other areas of orthopaedics on the basis of more rapid recovery and improved postoperative pain control. We hypothesized that a short course of postoperative dexamethasone following posterior spinal fusion for the treatment of adolescent idiopathic scoliosis (AIS) would decrease opioid usage without increasing wound-healing problems.

Methods: 

Consecutive patients undergoing posterior spinal fusion for the treatment of AIS from 2015 to 2018 at a single hospital were included. A review of demographic characteristics, curve characteristics, surgical data, and postoperative clinic notes was performed. Opioid usage was determined by converting all postoperative opioids given into morphine milligram equivalents (MME).

Results: 

Sixty-five patients underwent posterior spinal fusion for the treatment of AIS without postoperative steroids (the NS group), and 48 patients were managed with 3 doses of postoperative steroids (the WS group) (median, 8.0 mg/dose). There was no difference between the groups in terms of curve magnitude, number of vertebrae fused, or estimated blood loss. There was a 39.6% decrease in total MME used and a 29.5% decrease in weight-based MME used in the group receiving postoperative steroids (82.0 mg [1.29 mg/kg] in the NS group versus 49.5 mg [0.91 mg/kg] in the WS group]; p < 0.001). This difference persisted after accounting for gabapentin, ketorolac, and diazepam usage; surgical time; curve size; levels fused; and number of osteotomies (median decrease, 0.756 mg/kg [95% CI, 0.307 to 1.205 mg/kg]; p = 0.001). Three patients in the NS group (4.6%) and 4 patients in the WS group (8.3%) developed wound dehiscence requiring wound care (p = 0.53). One patient in the NS group required surgical debridement for the treatment of an infection. Patients in the WS group were more likely to walk at the time of the initial physical therapy evaluation (60.4% versus 35.4%; p = 0.013).

Conclusions: 

A short course of postoperative steroids after posterior spinal fusion was associated with a 40% decrease in the use of opioids, with no increase in wound complications. Surgeons may consider the use of perioperative steroids in an effort to decrease the use of postoperative opioids following posterior spinal fusion for the treatment of AIS.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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脊柱后路融合术后青少年地塞米松治疗青少年特发性脊柱侧弯

背景： 

由于伤口并发症的风险，外科医生在接受后路脊柱融合术的患者中犹豫使用类固醇。文献支持在更快速的恢复和改善的术后疼痛控制的基础上，在骨科的其他领域使用术后类固醇。我们假设后路脊柱融合术后短期地塞米松治疗青少年特发性脊柱侧凸（AIS）将减少阿片类药物的使用，而不会增加伤口愈合的问题。

方法： 

纳入自2015年至2018年在同一家医院接受脊柱后路融合治疗AIS的连续患者。人口统计学特征，曲线特征，手术数据和术后临床笔记进行了审查。阿片类药物的使用是通过将所有术后阿片类药物转换为吗啡毫克当量（MME）来确定的。

结果： 

65例患者接受了脊柱后路融合术治疗无术后类固醇的AIS（NS组），而48例患者接受了3剂术后类固醇治疗（WS组）（中位数为8.0 mg /剂量）。两组之间在曲线大小，融合椎骨数量或估计失血方面无差异。术后接受类固醇治疗的组中，使用的MME总量下降了39.6％，基于体重的MME下降了29.5％（NS组为82.0 mg [1.29 mg / kg]，而NS组为49.5 mg [0.91 mg / kg]）。 WS组]； p <0.001）。考虑加巴喷丁，酮咯酸和地西epa的使用后，这种差异仍然存在。手术时间 曲线大小；水平融合；和截骨的数量（中位数下降0.756 mg / kg [95％CI，0.307至1.205 mg / kg]； p = 0.001）。NS组中有3例患者（4。WS组中有6％的患者）和4例患者（8.3％）出现伤口裂开需要伤口护理（p = 0.53）。NS组中的一名患者需要手术清创以治疗感染。WS组的患者在初次物理治疗评估时更可能走路（60.4％对35.4％； p = 0.013）。

结论： 

脊柱后路融合术后短暂的类固醇激素治疗使阿片类药物的使用减少了40％，伤口并发症没有增加。外科医生可能会考虑围手术期使用类固醇，以减少脊柱后路融合术后使用阿片类药物治疗AIS的努力。

证据级别： 

治疗级别III。有关证据水平的完整说明，请参见《作者说明》。